PRENATAL MONITORING OF PREGNANCIES COMPLICATED BY DIABETES MELLITUS

Maja Macura, Stefan Dugalic, Jovana Todorovic, Bojana Gutic, Milos Milincic, Dragana Bozic, Milica Stojiljkovic, Jelena Micic, Miroslava Gojnic

Abstract


Preconception and prenatal monitoring evaluate the condition of the mother's underlying disease and possible complications during pregnancy. Before conception, patients with diabetes should be informed that suboptimal glycoregulation is associated with reduced fertility and pregnancy losses. The task of the perinatologist in pregnancies affected by diabetes mellitus is to prevent complications of the underlying disease, such as hypoglycemic crises. Another important component of prenatal care in diabetic pregnancies is the recognition and prevention of pregnancy complications such as preeclampsia, polyhydramnios, congenital malformations, fetal macrosomia, and infections.


Keywords


diabetes mellitus, pregnancy, complications, preeclampsia, polyhydramnios

Full Text:

PDF

References


Gojnic Dugalic M. et al. Diabetes i trudnoća. Medicinski fakultet Univerziteta u Beogradu: Novo doba, 2012.

Hubberd AL, Watson NA, Cobb E, Wardian JL, Morrow CC, Sauerwein TJ. Preconception counseling for women with diabetes. Clin Diabetes. 2020;38(1):98-100. doi: 10.2337/cd18-0109.

Mijatovic-Vukas J, Capling L, Cheng S, Stamatakis E, Louie J, Cheung NW, et al. Associations of diet and physical activity with risk for gestational diabetes mellitus: a systematic review and meta-analysis. Nutrients. 2018;10(6):698. doi: 10.3390/nu10060698.

Nagpal TS, Tomiyama AJ, Incollingo Rodriguez AC. Beyond BMI: Pregnancy-related weight stigma increases risk of gestational diabetes. Prim Care Diabetes. 2021;15(6):1107-9.

doi: 10.1016/j.pcd.2021.07.002.

Buschur EO, Polsky S. Type 1 Diabetes: management in women from preconception to postpartum. J Clin Endocrinol Metab. 2021;106(4):952-67. doi: 10.1210/clinem/dgaa931.

Wahabi HA, Fayed A, Esmaeil S, Elmorshedy H, Titi MA, Amer YS, et al. Systematic review and meta-analysis of the effectiveness of pre-pregnancy care for women with diabetes for improving maternal and perinatal outcomes. PLoS One. 2020;15(8):e0237571.

doi: 10.1371/journal.pone.0237571.

Polasek TM, Doogue MP, Thynne TRJ. Metformin treatment of type 2 diabetes mellitus in pregnancy: update on safety and efficacy. Ther Adv Drug Saf. 2018;9(6):287-95.

doi: 10.1177/2042098618769831.

Bishop KC, Harris BS, Boyd BK, Reiff ES, Brown L, Kuller JA. Pharmacologic treatment of diabetes in pregnancy. Obstet Gynecol Surv. 2019;74(5):289-97. doi: 10.1097/OGX.0000000000000671.

Grieger JA. Preconception diet, fertility, and later health in pregnancy.Curr Opin Obstet Gynecol. 2020;32(3):227-32.

doi: 10.1097/GCO.0000000000000629.

Thong EP, Codner E, Laven JSE, Teede H. Diabetes: a metabolic and reproductive disorder in women. Lancet Diabetes Endocrinol. 2020;8(2):134-49. doi: 10.1016/S2213-8587(19)30345-6.

Mattsson K, Nilsson-Condori E, Elmerstig E, Vassard D, Schmidt L, Ziebe S, et al. Fertility outcomes in women with pre-existing type 2 diabetes-a prospective cohort study. Fertil Steril. 2021;116(2):505-13. doi: 10.1016/j.fertnstert.2021.02.009.

Livshits A, Seidman DS. Fertility issues in women with diabetes. Womens Health (Lond). 2009;5(6):701-7. doi: 10.2217/whe.09.47.

Lin YH, Chen KJ, Peng YS, Chen PC, Yang YH. Type 1 diabetes impairs female fertility even before it is diagnosed. Diabetes Res Clin Pract. 2018;143:151-8. doi: 10.1016/j.diabres.2018.07.010.

Kalter H. Diabetes and spontaneous abortion: a historical review. Am J Obstet Gynecol. 1987;156(5):1243-53.

doi: 10.1016/0002-9378(87)90156-6.

Wright AD, Nicholson HO, Pollock A, Taylor KG, Betts S. Spontaneous abortion and diabetes mellitus. Postgrad Med J. 1983;59(691):295-8. doi: 10.1136/pgmj.59.691.295.

Combs CA, Kitzmiller JL. Spontaneous abortion and congenital malformations in diabetes.BaillieresClinObstetGynaecol. 1991;5(2):315-31. doi: 10.1016/s0950-3552(05)80100-2.

Jovanovic L, Metzger BE, Knopp RH, Conley MR, Park E, Lee YJ, et al. The diabetes in early pregnancy study: beta-hydroxybutyrate levels in type 1 diabetic pregnancy compared with normal pregnancy. NICHD-Diabetes in Early Pregnancy Study Group (DIEP).National Institute of Child Health and Development.Diabetes Care. 1998;21(11):1978-84. doi: 10.2337/diacare.21.11.1978.

Martin RB, Duryea EL, Ambia A, Ragsdale A, Mcintire D, Wells CE, et al. Congenital malformation risk according to hemoglobin A1c values in a contemporary cohort with pregestational diabetes. Am J Perinatol. 2021;38(12):1217-22. doi: 10.1055/s-0041-1730435.

Brown J, Grzeskowiak L, Williamson K, Downie MR, Crowther CA. Insulin for the treatment of women with gestational diabetes. Cochrane Database Syst Rev. 2017;11(11):CD012037.

doi: 10.1002/14651858.CD012037.pub2.

ter Braak EW, Evers IM, Willem Erkelens D, Visser GH. Maternal hypoglycemia during pregnancy in type 1 diabetes: maternal and fetal consequences. Diabetes Metab Res Rev. 2002;18(2):96-105.

doi: 10.1002/dmrr.271.

Coustan DR, Widness JA, Carpenter MW, Rotondo L, Pratt DC, Oh W. Should the fifty-gram one-hour glucose screening test for gestational diabetes be administered in the fasting or fed state? Am J Obstet Gynecol. 1986;154(5):1031–5.

doi: 10.1016/0002-9378(86)90744-1.

Steel JM, Johnstone FD. Guidelines for the management of insulin-dependent diabetes mellitus in pregnancy.Drugs. 1996;52(1):60-70. doi: 10.2165/00003495-199652010-00005.

Hellmuth E, Damm P, Mølsted-Pedersen L, Bendtson I. Prevalence of nocturnal hypoglycemia in the first trimester of pregnancy in patients with insulin-treated diabetes mellitus. Acta Obstet Gynecol Scand. 2000;79(11):958-62.

Kitzmiller JL, Gavin LA, Gin GD, Jovanovic-Peterson L, Main EK, Zigrang WD. Preconception care of diabetes. Glycemic control prevents congenital anomalies. JAMA. 1991;265(6):731-6.

Kimmerle R, Heinemann L, Dalecki A, Berger m. Severe hypoglycemia incidence and predisposing factors in 85 pregnancies of type 1 diabetic women. Diabetes Care. 1992;15(8):1034-7.

doi: 10.2337/diacare.15.8.1034.

Rosenn B, Miodovnik M, Coombs CA, Williams T, Wittekind C, Siddiqi TA. Human versus animal insulin in the management of insulin-dependent diabetes: lack of effect on fetal growth. Obstet Gynecol.1991;78(4):590-3.

Gabbe SG, Gregory RP, Power ML, Wiliams SB, Schulkin J. Management of diabetes mellitus by obstetrician-gynecologists. Obstet Gynecol.2004;103*6(:1229-34.

doi: 10.1097/01.AOG.0000128045.50439.89.

Björklund A, Adamson U, Andréasson K, Carlström K, Hennen G, Igout A, et al. Hormonal counterregulation and subjective symptoms during induced hypoglycemia in insulin-dependent diabetes mellitus patients during and after pregnancy. Acta Obstet Gynecol Scand. 1998;77(6):625-34. doi: 10.1034/j.1600-0412.1998.770609.x.

Hanson U, Persson B. Outcome of pregnancies complicated by type 1 insulin-dependent diabetes in Sweeden: acute pregnancy complications, neonatal mortality, and morbidity. Am J Perinatol.1993;10(4):330-3. doi: 10.1055/s-2007-994754.

Siddiqi T, Rosenn B, Mimouni F, Khoury J, Miodovnik M. Hypertension during pregnancy in insulin-dependent diabetic women. Obstet Gynecol. 1991;77(4):514-9.

Martin A, O'Sullivan AJ, Brown MA. Body composition and energy metabolism in normotensive and hypertensive pregnancy.BJOG. 2001;108(12):1263-71. doi: 10.1111/j.1471-0528.2001.00289.x.

Combs CA, Rosenn B, Kitzmiller JL, Khoury JC, Wheeler BC, Miodovnik M. Early-pregnancy proteinuria in diabetes related to preeclampsia. Obstet Gynecol. 1993;82(5):802-7.

Ekbom P, Damm P, Feldt-Rasmussen B, Feldt-Rasmussen U, Mølvig J, Mathiesen ER. Pregnancy outcome in type 1 diabetic women with microalbuminuria. Diabetes Care. 2001;24(10):1739-44.

doi: 10.2337/diacare.24.10.1739.

Griggs KM, Hrelic DA, Williams N, McEwen-Campbell M, Cypher R. Preterm labor and birth: a clinical review. MCN Am J Matern Child Nurs. 2020;45(6):328-37. doi: 10.1097/NMC.0000000000000656.

Green JR, Pawson IG, Schumacher LB, Perry J, Kretchmer N. Glucose tolerance in pregnancy: ethnic variation and influence of body habitus. Am J Obstet Gynecol.1990;163(1 Pt 1):86-92.

doi: 10.1016/s0002-9378(11)90675-9.

Kovilam O, Khoury J, Miodovnik M, Chames M, Spinnoto J, Sibai B. Spontaneous preterm delivery in type 1 diabetic pregnancy: the role of glycemic control. J Matern Fetal Neonatal Med. 2002;11(4):245-8. doi: 10.1080/jmf.11.4.245.248.

Sibai BM, Caritis S, Hauth J, Lindheimer M, VanDorsten JP, MacPherson C, et al. Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus. Neonatal Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Am J Obstet Gynecol.2000;182(2):364-9. doi: 10.1016/s0002-9378(00)70225-0.

Weiss PAM, Haeusler M, Kainer F, Pürstner P, Haas J. Toward universal criteria for gestational diabetes: relationships between seventy-five and one hundred gram glucose loads and between capillary and venous glucose concentrations. Am J Obstet Gynecol.1998;178(4):830-5. doi: 10.1016/s0002-9378(98)70500-9.

Yogev Y, Langer O. Spontaneous preterm delivery and gestational diabetes: the impact of glycemic control. Arch Gynecol Obstet. 2007;276(4):361-5. doi: 10.1007/s00404-007-0359-8.

Cousins L. Pregnancy complications among diabetic women: review 1965-1985. Obstet Gynecol Surv. 1987;42(3):140-9.

Lufkin EG, Nelson RL, Hill LM, Melton LJ 3rd, O'Fallon WM, Evans AT 3rd. An analysis of diabetic pregnancies at Mayo Clinic, 1950-79.Diabetes Care. 1984;7(6):539-47. doi: 10.2337/diacare.7.6.539.

Vejlsgaard R. Studies on urinary infections in diabetics. IV. Significant bacteriuria in pregnancy in relation to the age of onset, duration of diabetes, angiopathy and urological symptoms. Acta Med Scand. 1973;193(4):343-6.

Diamond MP, Entman SS, Salyer SL, Vaughn WK, Boehm FH. Increased risk of endometritis and wound infection after cesarean section in insulin-dependent diabetic women. Am J Obstet Gynecol. 1986;155(2):297-300. doi: 10.1016/0002-9378(86)90813-6.

Pedersen J, Pedersen LM, Andersen B. Assessors of fetal perinatal mortality in diabetic pregnancy. Analysis of 1,332 pregnancies in the Copenhagen series, 1946-1972.Diabetes. 1974;23(4):302-5. doi: 10.2337/diab.23.4.302.

Stamler EF, Cruz ML, Mimouni F, Rosenn B, Siddiqi T, Khoury J, et al. High infectious morbidity in pregnant women with insulin-dependent diabetes: an understated complication. Am J Obstet Gynecol.1990;163(4 Pt 1 ):1217-21.

doi: 10.1016/0002-9378(90)90694-3.




DOI: http://dx.doi.org/10.5937/sanamed0-40168

Refbacks

  • There are currently no refbacks.


Copyright (c) 2022 Maja Macura, Stefan Dugalic, Jovana Todorovic, Bojana Gutic, Milos Milincic, Dragana Bozic, Milica Stojiljkovic, Jelena Micic, Miroslava Gojnic

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.